Cataracts Flashcards
What is a cataract?
Opacity (cloudiness) of the usually clear, transparent crystalline lens of the eyes.
What field of vision is affected by cataracts?
The entire field of vision
Clinical manifestations associated with cataracts?
- Decreased visual acuity
- Glare
- Abnormal color perception
- As cataract worsens, stronger corrective lenses no longer improve sight
- Some degree of functional impairment
How does glare affect vision?
- As the lens becomes opaque, it scatters light instead of transmitting a sharply focused image.
- This results in a disabling glare, dimmed or blurred vision with distorted images.
- May be significantly worse at night when the pupil dilates (lets in more light)
What are some examples of situations that cause glare?
- Reading on slick, shiny paper
- Shiny floors
- Driving at night
Safety implications associated with glare?
- Driving hazard
- Falls and mobility issues
- Reduced reaction time
- Hinders ability to perform everyday activities
What may or may not be seen when the provider performs a fundoscopic examination?
- No visualization of the retina with an ophthalmoscope.
- Pupil may appear yellowish, gray, or white (ordinarily black)
Explain the non-surgical treatment strategies for cataracts.
- There is no treatment to cure cataracts other than surgical removal.
- Changing eyewear may improve visual acuity (does not help with cloudiness)
- Increasing the amount of light to read or do other near-vision tasks
- opening blinds
- change to LED bulbs (casts less glare)
- Adjusting lifestyle to adjust to visual decline
- avoid driving at night
Describe the surgical treatment strategies for cataracts.
- The presence of a cataract does not necessarily indicate a need for surgery.
- Cataracts cannot be removed by laser surgery.
- Most surgeries are performed under local anesthetic, which immobilizes the eye.
Nursing interventions during the pre-operative phase?
- Obtain a history and physical exam
- Most patients receive local anesthesia and will not require an extensive pre-op physical exam
- Older patients usually have pre-existing medical conditions that need to be evaluated and controlled before surgery
What occurs during the pre-op phase?
The patient usually arrives several hours before the actual surgery to allow time for preoperative procedures (eye exams)
Why is it necessary for someone to accompany the patient to surgery?
- Will require someone who can drive them home because they will be given a sedative
- Medications and eye drops will alter vision
What is the rationale for the use of NSAIDs and sedatives in the pre-op phase?
- NSAID eye drops = to reduce inflammation
- Sedatives = to manage anxiety and discomfort
Describe the two dilating drops used pre-op for cataracts.
- Mydriatics:
- Dilates pupil
- Cycloplegics:
- Dilates pupil
- Paralyzes or immobilizes the eye
What are the two surgical treatments for cataracts?
- Phacoemulsification
- Extracapsular cataract extraction
Describe Phacoemulsification.
- A very small incision is made in the eye’s surface in or near the cornea.
- A thin ultrasound probe is inserted into the eye, and ultrasonic vibrations dissolve the clouded lens into fragments.
- These pieces are then suctioned out through the same ultrasound probe.
- The small incisions are self-sealing and usually do not need sutures.
- A new intraocular lens (IOL) is placed
Explain extracapsular cataract extraction.
- Used for very advanced cataracts where the lens is too dense to dissolve into fragments.
- A larger incision is required so the cataract can be removed in one piece without being fragmented inside the eye.
- Sutures are needed to close the larger wound.
- Visual recovery is often slower
- A new intraocular lens (IOL) is placed
What is an intraocular lens (IOL)?
A small, artificial lens that is implanted inside the eye to replace the natural lens
Complications of cataracts surgery / IOL?
- Glaucoma
- Hemorrhage
- Corneal epithelial damage
- Uveitis (inflammation of the uvea)
- Malpositioning of the IOL
- Formation of secondary membranes (scar tissue)
- Pupillary block
- Wound fistula
infection & hemorrhage always a complication!
just know that any surrounding tissue in the eye can be damaged
Discharge instructions given during the post-operative phase?
- Post-op meds usually include antibiotic drops to prevent infection and corticosteroid drops to decrease the inflammatory response.
- Eye shielding when they’re sleeping
- Don’t want position changes to alter the position of the IOL
- Sunglasses when outdoors in bright light
- Avoid activities that increase the IOP, such as bending, coughing, or lifting (approx. 1 week)
- Need for protection must be emphasized because many patients are older, have increased risk for falling, leading to blunt trauma to the eye which could rupture the globe, causing loss of vision.
Avoid anything that increases the pressure in the eye!
Gerontological considerations related to a patient who has cataracts.
- When an older patient is visually impaired, even temporarily, the patient may experience:
- loss of independence
- lack of control over their life
- significant change in self-perception
- The older patient often needs emotional support and encouragement, as well as specific suggestions to allow a maximum level of independent function.
- Assure the older patient that cataract surgery can be done safely and comfortably with minimal sedation.
How to instill eye drops?
- Tilt your head back
- Pull your lower eyelid down and away from eyeball to form a pocket
- Hold the eye drop bottle upside down
- Squeeze the prescribed number of eye drops into the pocket
- Close your eye and press your finger lightly on your tear duct
- this keeps eye drop from draining into nose
- If they’re taking more than one eye drops, wait at least 15 min between each
- If you normally wear contact lens, you need to take the contacts out before instilling the eye drops (wait 15 min before putting contacts back in)
